Albumin-myosteatosis gauge as a prognostic factor in patients with advanced pancreatic cancer undergoing first-line chemotherapy

BACKGROUND

Sarcopenia and myosteatosis have been associated with a poor prognosis for several cancers. The albumin-myosteatosis gauge (AMG) is a novel integrated measure proposed to assess myosteatosis along with serum albumin level as a surrogate of systemic inflammation and malnutrition. The aim of this study was to investigate the prognostic value of AMG in patients with advanced pancreatic ductal adenocarcinoma (PDAC).

METHODS

Patients with advanced PDAC treated with chemotherapy between 2013 and 2022 were evaluated. Skeletal muscle radiodensity (SMD) and skeletal muscle index (SMI) were calculated using computed tomography at the level of the L3 vertebra. The AMG was defined as albumin x SMD and expressed as an arbitrary unit (AU). Patients were first categorized by sex-specific quartiles and then dichotomized at the sex-specific median value of the AMG.

RESULTS

A total of 196 patients were included. The median age (interquartile range) was 62 (54-67), and 128 (65.3%) were male. With regard to AMG, 142.86 and 114.15 AU were identified as cutoff values for males and females, respectively. In multivariable analyses, lower AMG values (G1-G2 vs. G3-G4) (HR: 1.61, 95% CI 1.17-2.21, p = 0.003), higher ECOG performance score (> 0 vs. 0) (HR: 1.51, 95% CI 1.10-2.06, p = 0.009) and metastatic disease (vs. locally advanced) (HR: 1.88, 95% CI 1.27-2.79, p = 0.001) were associated with OS.

CONCLUSION

The study findings suggest the prognostic value of AMG in patients with advanced PDAC undergoing first-line chemotherapy. Further studies are warranted to validate these findings and assess potential predictive role of AMG in guiding treatment selection.

Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma

Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.

The impact of endodontic workload and allocated treatment time of dentists in turkey on perceived stress and complication frequency and suggested solutions

Background

Procedural complications and workload have been reported as sources of stress in dentistry.

Aim

To investigate the impact of endodontic workload and allocated treatment time of dentists on perceived stress and frequency of complications.

Material and Methods

The online survey included questions to evaluate the average number of root canal treatments per week, stress levels during root canal treatment, frequency of single-visit root canal treatments, time spent on single-visit treatments, frequency of endodontic complications per week, preference for management of complication, and proposed solutions.

Results

A negative correlation was found between endodontic workload and perceived stress, which was statistically significant at slight and moderate stress levels (P < 0.05). Amongst the clinicians who feel "very stressful" during the treatment, the clinicians who allocate only 20 minutes or less per treatment had the highest frequency, and their numbers were significantly higher than clinicians who spent 20-40 minutes per treatment (P < 0.05). Amongst the clinicians who experience instrument separation 4-6 times/week, the number of clinicians who spent 40-60 minutes or more than 60 minutes per root canal treatment was significantly lower in comparison to the number of clinicians who spent 20-40 minutes (P < 0.05).

Conclusion

Increasing the quality of dental equipment and reducing the time pressure on dentists might result in lesser stress levels of clinicians and fewer endodontic complications.

'Staged' liver resection in synchronous and metachronous colorectal hepatic metastases: differences in clinicopathological features and outcome

AIM

Approximately 25% of the patients with colorectal cancer already have liver metastases at diagnosis and another 30% will develop them subsequently. The features and prognosis of patients with synchronous and metachronus colorectal liver metastases, treated with primary resection first followed by partial liver resection were analysed.

METHOD

Curative staged resection of liver metastases was performed in 272 consecutive patients. Demographics, characteristics of the primary tumour and metastatic tumours, surgery-related data and outcome were analysed.

RESULTS

Synchronous metastases were present in 105 (39%) patients and metachronous metastases in 167 (61%). More patients in the synchronous group had an advanced primary tumour (T3/T4 and/or node positivity), more than three liver metastases and bilobar distribution. A significantly higher percentage of patients in the synchronous group received neoadjuvant chemotherapy. The 5-year survival rate in the group of 272 patients was 38%. Patients with more than three metastases had a significantly worse survival rate. There were no differences in disease-free and overall survival rates between the synchronous and metachronous group.

CONCLUSION

Although patients with synchronous colorectal liver metastases may have poorer biological features, there was no difference in 5-year disease-free and overall survival compared with patients with metachronous metastases. This may be explained by the observation that patients in the synchronous group received significantly more neoadjuvant chemotherapy.